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The vacant Martin County General Hospital sits abandoned behind a chain since being closed in August of 2023 in Williamston, North Carolina.<\/span>Karl B DeBlaker\/AP<\/span><\/p>\n<\/div>\n The GOP\u2019s \u201cBig Beautiful Bill,\u201d<\/span> which cleared the Senate Tuesday afternoon and is returning to the House, is generally terrible for families. But women and babies who live in areas that voted overwhelmingly for Donald Trump are likely to suffer some of its most sweeping and damaging effects.<\/p>\n The historically brutal Medicaid cuts\u2014a staggering $930 billion<\/a> slashed from the program over the next decade\u2014could force as many as 144 rural hospitals around the US to close their labor-and-delivery units or drastically scale back services, a new analysis<\/a> by the National Partnership for Women & Families<\/a> projects. That could have potentially catastrophic consequences for maternal and infant health.<\/p>\n \u201cWhen somebody is in labor or having a pregnancy-related emergency, every second counts,\u201d says Rolonda Donelson, lead author of the analysis. \u201cAnd with these hospital closures, people are going to have to travel further and further to get the help that they need.\u201d<\/p>\n Medicaid is one of the most important safety nets for low-income women during pregnancy and the postpartum period, paying for 41 percent<\/a> of births in the US\u2014about 1.5 million babies a year. The program plays a particularly vital role in rural areas, covering the costs of 47 percent of births in those communities in 2023<\/a>. Even with Medicaid support, the maternal mortality rate among rural women is almost twice as high<\/a> as in urban areas; unsurprisingly, infant mortality is significantly higher<\/a> as well.\u00a0<\/p>\n Medicaid is likewise a critical safety net for the country\u2019s 1,800 rural hospitals<\/a>, helping defray the cost of caring for some 16 million rural residents who would otherwise be uninsured<\/a>. Without Medicaid payments, many rural hospitals\u2014which tend to be smaller and less profitable<\/a> than their urban counterparts\u2014would be at serious risk of going under. As it is, almost 150 rural hospitals stopped inpatient services or shut down completely from 2005 to 2023, the federal government says<\/a>.\u00a0The GOP megabill puts another 338 rural hospitals at risk, University of North Carolina researchers warned<\/a> in a letter in June.<\/p>\n As rural hospitals have struggled to stay open, labor-and-delivery departments have been among the services at greatest risk of being slashed. That\u2019s because reimbursements by both private insurance and Medicaid are often too low to cover the costs of obstetric services, and rural hospitals don\u2019t make enough money from other types of services to offset those losses. Since 2020, more than 100 rural hospitals have shuttered their maternity units or announced plans to close, according to<\/a> the Center for Healthcare Quality & Payment Reform, a national think tank; only 42 percent of rural hospitals still offer labor-and-delivery services, while in 11 states, fewer than one-third do.<\/p>\n Thus, vast parts of rural America are already maternity care deserts<\/a>, forcing pregnant patients to\u00a0travel further for prenatal care, deterring them from seeking immediate medical treatment when they suffer complications that might be life-threatening, and making them less likely to receive follow-up care after giving birth.<\/p>\n \u201cWhen somebody is in labor or having a pregnancy-related emergency, every second counts, and with these hospital closures, people are going to have to travel further and further to get the help that they need.\u201d<\/p>\n<\/blockquote>\n<\/figure>\n The GOP cuts and changes to Medicaid and the Affordable Care Act will make that situation much worse, leading to 17 million people becoming uninsured, Donelson estimates. \u201cThis will disproportionately impact women because they are more likely to have Medicaid health insurance,\u201d she adds.<\/p>\n More than 60 percent of the rural labor-and-delivery units at risk are in red and purple states that went for Trump in 2024. Trump won rural voters by 40 points last November, a Pew<\/a> analysis found.<\/p>\n As my Mother Jones<\/em> colleague, Michael Mechanic has reported<\/a>, when ordinary Republicans are informed about how the budget megabill<\/a>\u2014a package of tax and spending cuts that would add an estimated $3.3 trillion<\/a> to the deficit\u2014would affect the after-tax incomes of American families, they hate<\/a> it. \u201cApparently even Trump\u2019s die-hard fans are appalled when they are shown how the bill\u2019s provisions will affect the finances of the nation\u2019s richest and poorest households,\u201d Mechanic wrote, \u201cnot that they\u2019d ever hear it on Fox News.\u201d <\/p>\n While the proposed cuts to Medicaid will be devastating for all rural hospitals, those in states that expanded Medicaid under the Affordable Care Act will be hardest hit, Donelson says. The GOP bill \u201creally just shifts a lot of these costs from the federal government onto states that already [are struggling] to afford this,\u201d making it \u201cthat much more expensive to cover those in the Medicaid expansion population,\u201d she says.<\/p>\n According to the National Partnership\u2019s analysis, the states facing the greatest threats to rural maternity care are Kentucky and California, each with 13 rural obstetric departments at risk of closure; New Mexico, which has 11; and Louisiana, where ten obstetric units are at risk. Unlike some other conservative holdouts<\/a>, Kentucky and Louisiana both expanded Medicaid. As Sharona Hoffman, co-director of Case Western Reserve University\u2019s Law-Medicine Center, told<\/a> my colleague Julia M\u00e9traux, Republicans\u2019 new cuts seem intended to undercut Medicaid expansion. \u201cThe goal, I think, is to get states to say, \u2018Well, we\u2019re not getting the federal money support, and so we\u2019re going to roll back or undo our expansion of Medicaid,\u2019\u201d Hoffman said.<\/p>\n In total, 41 states could lose labor-and-delivery units in their rural hospitals because of GOP Medicaid cuts, Donelson says. The only reason The cutbacks and closures won\u2019t just affect patients; they will also have a profoundly destructive impact on rural jobs and economies, where hospitals typically serve as one of the biggest employers in their communities. According to the National Partnership analysis, more than 80 percent of people working in hospitals in non-metro areas are women.<\/p>\n The Trump\/GOP mega-bill also includes many other provisions that will disproportionately affect women and children, from defunding Planned Parenthood<\/a> to gutting spending on food stamps<\/a>.<\/p>\n Reproductive justice groups lost no time in excoriating the Senate after today\u2019s vote. \u201cFor the past six months, people in all 50 states have been grappling with the chaos unleashed by the Trump administration\u2019s cuts, freezes, and destruction of critical federal programs\u2014and now Congressional Republicans are pouring gasoline on the fire,\u201d Jennifer Driver<\/a>, senior director of reproductive rights at State Innovation Exchange, said in a statement. \u201cInstead of helping people make ends meet by lowering costs, Senate Republicans are choosing cruelty over solutions.\u201d\u00a0<\/p>\n \u201cThe Senate\u2019s version of the bill is just as dangerous and devastating as the one passed by the House and attacks our communities\u2019 health, dignity, and futures,\u201d echoed Lupe M. Rodr\u00edguez, executive director of the National Latina Institute for Reproductive Justice. \u201cLet it be very clear, instead of helping people stay healthy and safe, it puts our communities at risk only to serve the interests of the billionaires.\u201d<\/p>\n<\/p><\/div>\n\n
<\/s><\/strong>some other states\u2014including Arkansas and Alabama\u2014won\u2019t see cuts is because these states \u201calready have limited maternal health services,\u201d she says.<\/p>\n